Ask the expert: Dr. Anis Rauf and what you should know about kidney disease

Boston Market reducing sodium in three signature dishes

Dr. Anis Rauf: "There's nothing wrong with salt, as long as you use it in moderation and you don’t have kidney disease or high blood pressure. … If you do, salt is the root of all evils."
(Mario Tama, Getty Images)

We think about being heart healthy. We think about strengthening our bones. But we rarely pondered the state of our kidneys — that is, until Boston Market announced last month that it was removing salt shakers from the tables at its 476 locations.

In addition, the national chain reported it would also reduce sodium levels by 20 percent in three signature dishes: rotisserie chicken, macaroni and cheese, and mashed potatoes.

To shed some light on chronic kidney disease, we turned to Dr. Anis Rauf, a board-certified nephrologist at U.S. Renal Care, which opened its first Illinois dialysis facility in Streamwood in July, with two more scheduled to open, one in Downers Grove and one in Bolingbrook, this fall.

Q. It seems like everywhere I turn I'm reading about kidney disease. Why does there seem to be more awareness?

A. The first is because of the aging population. As we get older, the kidneys get older too … and we have better tests today to assess how well the kidneys are or are not functioning. Second would be the increase over the last 10 years in diabetes and hypertension, diseases that affect the kidneys. Finally, the demographic changes of the country play a part too. Hispanic and African-American populations are growing, and they have a significantly higher incidence of kidney disease than whites.

Q. What are the symptoms of kidney disease?

A. In the early stages, you might not have many symptoms. You may need to urinate more often or less often … or you may notice more foaminess in your urine. You may lose your appetite or experience nausea and vomiting. Your legs or feet may swell … which is a sign that your body can't get rid of the salt.

Q. If you suspect that you have a problem, what should you do?

A. Go to your physician, who will do blood tests. In the lab, your blood will be tested for creatinine … and if there's too much, there may be a problem. Creatinine is a waste product in the blood. … Healthy kidneys take it out and put it in the urine to leave the body. Another blood test is GFR, or glomerular filtration rate, which gives you a calculation that determines how well the blood is filtered by the kidneys. Generally, the lower the GFR number, the worse the kidney function. Then, urinalysis, which looks for protein in the urine. Even a microscopic amount of protein is abnormal.

Q. So, what should a health-conscious consumer do to ensure that their kidneys are working at full strength?

A. Probably the best thing you can do is pay attention to your blood pressure. Someone with kidney disease needs to have lower blood pressure than someone who doesn't. Watch your cholesterol and, of course, keep your diabetes under control. If your blood sugar is uncontrolled, it can cause deposits that punch holes in the membrane of the kidneys, causing protein to leak.

Q. What's the problem with salt? As vices go, isn't it preferable to fat or sugar?

A. There's nothing wrong with it, as long as you use it in moderation and you don't have kidney disease or high blood pressure. … If you do, salt is the root of all evils. The body is like a bath tub, and too much salt is like a clogged drain … so fluid accumulates. Americans should keep their sodium intake to about 2,000 milligrams of salt per day.

(Boston Market plans to reduce its macaroni and cheese from 1,100 mg to 880 mg, a quarter of rotisserie chicken will drop from 710 mg to 568 mg, and mashed potatoes will decrease from 820 mg to 607 mg.)

Q. You are a real Chicago success story, emigrating from Pakistan at age 4, valedictorian at Mather High School, followed by Northwestern University, University of Illinois and a nephrology fellowship at Loyola University. What drove you?

A. My mother had a lot of medical problems … so I was motivated by growing up in the Cook County health system. I always knew I wanted to bring quality care where I grew up.